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Palivizumab

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Palivizumab, Synagis

  • See Also
  1. Respiratory Syncytial Virus
  2. Pediatric Vaccination
  3. Bronchopulmonary Dysplasia
  • Indications
  • RSV Prophylaxis (AAP guidelines, 2014)
  1. Congenital airway, pulmonary or neuromuscular disorder interfering with secretion clearance in age <12 months
  2. Hemodynamically significant Congenital Heart Disease in age <12 months
  3. Severe Immunodeficiency in age <24 months
  4. Preterm Infants with Gestational age at birth <29 weeks and age <12 months
  5. Chronic lung disease of prematurity
    1. Age <12 months
      1. Gestational age <32 weeks AND
      2. Required Supplemental Oxygen >21% for at least 28 days after delivery
    2. Age <24 months
      1. Treatment (oxygen, broncodilators, steroids, Diuretics) within 6 months of RSV season start
  6. Cystic Fibrosis
    1. Age <12 months
      1. Findings of chronic lung disease or nutritional deficiency
    2. Age <24 months
      1. Weight for Length below 10th percentile OR
      2. Severe lung disease (respiratory related hospitalization in age <1 year or persistent CXR changes)
  • Mechanism
  1. Humanized mouse Monoclonal Antibody to RSV
  2. Provides passive Immunity to RSV in high risk infants
  • Dosing
  1. Palivizumab 15 mg/kg IM monthly for up to 5 months of RSV season
  2. Historically RSV season has been November 1 to March 1 in U.S.
    1. However post-2020 Covid, peak RSV season has shifted to spring-summer
  • Efficacy
  1. Decreases hospitalizations by 45 to 55%
  2. NNT 18 to prevent one RSV related hospitalization
  3. Does not decrease RSV related mortality
  • Resources
  1. Palivizumab Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3a0096c7-8139-44cd-bba4-520ab05c2cb2
  • References
  1. Pickering (2009) Red Book, AAP, Elk Grove Village, p. 560
  2. (2014) Pediatrics 134(2): e620-38 [PubMed]
  3. Gargnani (2021) Cochrane Database Syst Rev 11(11):CD013757 +PMID: 34783356 [PubMed]